■移动健康(mHealth)干预措施具有巨大的潜力,可以在涉及服药和其他自我管理活动的治疗方案后,为患有复杂疾病的人提供疾病自我管理。然而,对于在任何慢性疾病的有效依从性和促进自我管理的mHealth解决方案中应使用哪些离散行为改变技术(BCT),目前尚无共识.回顾现有文献,以确定有效的,mHealth干预措施中贯穿各领域的BCT,以促进依从性和自我管理,可以帮助加速发展,评估,以及在复杂医疗条件下具有潜在普遍性的行为改变干预措施的传播。
■这项研究旨在确定跨领域,基于mHealth的BCT将纳入对复杂医疗状况患者的有效mHealth依从性和自我管理干预措施,通过系统地回顾具有相似依从性和自我管理要求的慢性疾病的文献。
■进行了一项注册系统评价,以确定已发表的对具有复杂依从性和自我管理需求的慢性疾病的m健康依从性和自我管理干预措施的评估。使用标准数据收集表提取每个研究中的方法学特征和BCT。
■共审查了122项研究;大多数涉及2型糖尿病患者(28/122,23%),哮喘(27/122,22%),1型糖尿病(19/122,16%)。与对结果无影响的干预措施(平均3.57,SD1.95)或使用>1个结果测量或分析方法的干预措施(平均3.90,SD1.93;P=.02)相比,被评为对依从性和自我管理有积极结果的m健康干预措施使用了更多的BCT(平均4.95,SD2.56)。以下BCT与积极结果相关:行为的自我监测结果(39/59,66%),对行为结果的反馈(34/59,58%),行为自我监测(34/59,58%),行为反馈(29/59,49%),可靠来源(24/59,41%),和目标设定(行为;14/59,24%)。在仅限成人的样本中,提示和提示与阳性结局相关(34/45,76%).在青少年和年轻成人样本中,关于健康后果的信息(1/4,25%),解决问题(1/4,25%),和物质奖励(行为;2/4,50%)与积极结果相关。在明确针对服药的干预措施中,提示和提示(25/33,76%)和可信来源(13/33,39%)与阳性结局相关.在侧重于自我管理和其他依从性目标的干预措施中,关于如何执行行为的指令(8/26,31%),目标设定(行为;8/26,31%),行动计划(5/26,19%)与阳性结果相关.
■为了支持复杂医疗条件人群的依从性和自我管理,mHealth工具应有目的地纳入有效和适合发展的BCT。BCT选择的交叉方法可以加速为目标人群开发急需的mHealth干预措施,尽管mHealth干预开发人员在设计这些工具时应该继续考虑目标人群的独特需求。
UNASSIGNED: Mobile health (mHealth) interventions have immense potential to support disease self-management for people with complex medical conditions following treatment regimens that involve taking medicine and other self-management activities. However, there is no consensus on what discrete behavior change techniques (BCTs) should be used in an effective adherence and self-management-promoting mHealth solution for any chronic illness. Reviewing the extant literature to identify effective, cross-cutting BCTs in mHealth interventions for adherence and self-management promotion could help accelerate the development, evaluation, and dissemination of behavior change interventions with potential generalizability across complex medical conditions.
UNASSIGNED: This study aimed to identify cross-cutting, mHealth-based BCTs to incorporate into effective mHealth adherence and self-management interventions for people with complex medical conditions, by systematically reviewing the literature across chronic medical conditions with similar adherence and self-management demands.
UNASSIGNED: A registered systematic review was conducted to identify published evaluations of mHealth adherence and self-management interventions for chronic medical conditions with complex adherence and self-management demands. The methodological characteristics and BCTs in each study were extracted using a standard data collection form.
UNASSIGNED: A total of 122 studies were reviewed; the majority involved people with type 2 diabetes (28/122, 23%), asthma (27/122, 22%), and type 1 diabetes (19/122, 16%). mHealth interventions rated as having a positive outcome on adherence and self-management used more BCTs (mean 4.95, SD 2.56) than interventions with no impact on outcomes (mean 3.57, SD 1.95) or those that used >1 outcome measure or analytic approach (mean 3.90, SD 1.93; P=.02). The following BCTs were associated with positive outcomes: self-monitoring outcomes of behavior (39/59, 66%), feedback on outcomes of behavior (34/59, 58%), self-monitoring of behavior (34/59, 58%), feedback on behavior (29/59, 49%), credible source (24/59, 41%), and goal setting (behavior; 14/59, 24%). In adult-only samples, prompts and cues were associated with positive outcomes (34/45, 76%). In adolescent and young adult samples, information about health consequences (1/4, 25%), problem-solving (1/4, 25%), and material reward (behavior; 2/4, 50%) were associated with positive outcomes. In interventions explicitly targeting medicine taking, prompts and cues (25/33, 76%) and credible source (13/33, 39%) were associated with positive outcomes. In interventions focused on self-management and other adherence targets, instruction on how to perform the behavior (8/26, 31%), goal setting (behavior; 8/26, 31%), and action planning (5/26, 19%) were associated with positive outcomes.
UNASSIGNED: To support adherence and self-management in people with complex medical conditions, mHealth tools should purposefully incorporate effective and developmentally appropriate BCTs. A cross-cutting approach to BCT selection could accelerate the development of much-needed mHealth interventions for target populations, although mHealth intervention developers should continue to consider the unique needs of the target population when designing these tools.